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News, commentary and analysis for reproductive and sexual health and justice.Tue, 03 Mar 2015 22:56:00 +0000en-UShourly1http://wordpress.org/?v=4.1.1Five Things to Look for in Family Planning in 2013http://rhrealitycheck.org/article/2013/01/03/five-things-to-look-in-family-planning-in-2013/?utm_source=rss&utm_medium=rss&utm_campaign=five-things-to-look-in-family-planning-in-2013
http://rhrealitycheck.org/article/2013/01/03/five-things-to-look-in-family-planning-in-2013/#commentsThu, 03 Jan 2013 21:35:42 +0000In many ways, 2012 was a banner year for international family planning and reproductive health. What should we be looking for in 2013?

]]>In many ways, 2012 was a banner year for international family planning and reproductive health. The London Family Planning Summit galvanized political and (we hope) financial support for this issue to a new level, resulting in greater attention to the issues and opportunities. Contraception even became an issue in the U.S. presidential election with voters seemingly supportive of birth control.

What should we be looking for in 2013? We suggest the following issues:

London Family Planning Summit: It was a watershed event for international family planning. Many promises were made that, if kept, could provide contraception for 120 million women with an unmet need for family planning. In 2013, we will learn if those commitments were sincere and how they will translate into real programming. Delivery on these promises will be a significant step forward in improving the health and saving the lives of women.

The Private Sector: It will play an increasingly important role in the delivery of products and services. Survey data suggests that the private sector is delivering a majority of family planning in many African countries. Non-profit organizations like DKT have been employing social marketing strategies for decades by leveraging the private sector to bring products and services to those that need them. More recently, we have started using social franchising, a strategy for organizing (usually) private sector clinics to increase the quality and quantity of health providers and services. Organizations like the Acumen Fund are using “impact investments” made to generate measurable social and environmental impact along with a financial return. In October, the Social Capital Markets Conference discussed impact investments in the context of family planning or, as this article put it, “bringing the bedroom into the boardroom.” And, in a new brand of philanthropy, some nonprofits are investing in for-profits.

New Contraceptive Technologies: Contraceptives are becoming better and cheaper, which often leads to higher use. For example, Implanon and Jadelle implant prices dropped in 2012. New products now in development, and expected to enter the market in 2013, include:

Twirla is a low-dose, one-weekly contraceptive patch, with fewer side effects. The Food & Drug Administration is expected to make a decision on it in the first quarter of 2013.

A vaginal ring has been developed that can last 13 cycles (as opposed to three weeks) and requires no refrigeration.

The SILCS diaphragm is an advance over older diaphragms as one size will fit most users, and does not need to be tailored to specific users.

A generic hormonal intra-uterine system (IUS) should be available at lower prices in 2013, joining a number of recent advances in IUD technology.

PATH is developing a new women’s condom with a polyurethane pouch that adheres better to the vaginal wall and has a biodegradable capsule.

Misoprostol and Medical Abortion: Misoprostol (used both for safe abortion and post-partum hemorrhaging) and medical abortion are changing the landscape of reproductive health as abortion becomes more available, accessible and affordable. This has already happened in places like Latin America and we expect the same in the near future in Africa as well. For example, misoprostol is increasingly available and promoted in more countries. DKT International currently provides safe, affordable abortion in eight countries, and we are working to register misoprostol in several more. In India, DKT was the first organization to advertise medical abortion on national television.

Aid to Middle-Income Countries: Donors are moving away from middle-income countries like Indonesia, Mexico, Philippines, Turkey and Vietnam. In Latin America, the U.S. Agency for International Development has “graduated” most of its programs from family planning assistance. Just last month, the United Kingdom announced it was halting aid to India. In Indonesia, DKT has moved from donor financing to self-sufficiency in ten years. Yet middle-income countries are often big countries with huge pockets of unmet need. Are we cutting these countries off prematurely?

These are some of the major issues in international family planning that we will be looking for in 2013. What are yours? We welcome your comments below.

]]>http://rhrealitycheck.org/article/2013/01/03/five-things-to-look-in-family-planning-in-2013/feed/0It Takes a Village: Getting Family Planning Where It’s Neededhttp://rhrealitycheck.org/article/2012/08/02/it-takes-village-getting-family-planning-where-its-needed/?utm_source=rss&utm_medium=rss&utm_campaign=it-takes-village-getting-family-planning-where-its-needed
http://rhrealitycheck.org/article/2012/08/02/it-takes-village-getting-family-planning-where-its-needed/#commentsThu, 02 Aug 2012 08:37:58 +0000This unprecedented effort to fund family planning worldwide could be a major milestone in global health, development and women’s rights. But we need to make sure this new funding and political commitment is followed by swift action—and change felt on the ground.

July 11th was definitely momentous, but I don’t think the hundreds of thousands of women and girls that are displaced by conflict living in South Sudan’s villages heard the news. The Bill and Melinda Gates Foundation, the British government and other donors committed $2.6 billion dollars to give a projected 120 million women in the world’s poorest countries access to lifesaving contraception. This unprecedented effort could be a major milestone in global health, development and women’s rights. But we need to make sure this new funding and political commitment is followed by swift action—and change felt on the ground.

In the humanitarian settings where we work, we have found that few aid agencies and governments focus on family planning—even though it is a critical public health intervention that saves lives and has impact far beyond health. In the immediate aftermath of a disaster, men and women fleeing their homes are not likely to be thinking about their contraceptives as a first priority, and neither is it a main concern of humanitarian aid agencies responding to these crises. Yet, experience has shown us that even in the earliest days and weeks of a humanitarian emergency, women and girls want to use contraception.

Providing family planning information and services should be a top concern from the very onset of a crisis. Many countries have protracted humanitarian situations; the average length of displacement for people living in refugee camps is now 18 years. Not having family planning services available can have far-reaching and long-term effects: keeping young girls out of school, increasing the chances they will marry early, and raising rates of maternal and infant deaths.

There have been some significant improvements in reproductive health care in crisis situations. The humanitarian community, governments and others are working to ensure that a set of basic measures are taken during humanitarian crises to meet women’s and girls’ reproductive health concerns. Yet, family planning often falls by the way side.

In a five-country study we conducted in 2011, we found that use of contraception is generally lower in refugee camps than in surrounding areas. And awareness is low as well.

In recent years, several developing countries, like Bangladesh—which has successfully implemented a community-based approach—have seen improvements in family planning uptake. Now we need to make sure these programs and models are adapted and implemented in humanitarian settings on a wide scale—in the camps, villages, and urban areas where displaced persons live. Without this concerted effort, women and girls in regions hit by humanitarian crises will remain vulnerable to unplanned pregnancies and risk dying from complications.

Simple measures and methods that could protect them—like the pill or injectable contraceptives—are often neglected during crises. We have been working to develop educational materials that help local health providers and peer educators to explain the benefits of family planning and where and how to seek services. This outreach to communities is needed to really save lives and to ensure women and girls are informed and able to make choices about their futures.

Community members are often best positioned and able to respond to the needs of their peers. We have seen this in South Sudan, where the Women’s Refugee Commission worked with the American Refugee Committee and local partners on an initiative to assess whether training community members and peer educators to provide information on family planning—and to provide methods like the pill and condoms—is a feasible approach. Our project focused on the town of Malakal, which experiences heavy rain for half the year, decimating the few roads that exist. Needless to say, transportation is limited and health clinics are scarce. Prolonged conflict in the region further restricts access to whatever health care there is available.

We wanted to see if community workers making home visits and informing their peers about contraception, holding health education sessions in villages and doing radio shows would be effective. This approach did show potential: communities were open and enthusiastic about family planning. Adolescent girls, especially, were motivated to learn about and use contraception so they could stay in school and delay pregnancy.

Initiatives like these put family planning in the hands of those who would not be reached otherwise and are absolutely essential to improving reproductive health in the poorest parts of the world. Empowering communities, local leaders and health workers should be the next step in our global efforts. Without involving communities and engaging them from the start our plans will remain just that, no matter how good the intentions.

]]>http://rhrealitycheck.org/article/2012/08/02/it-takes-village-getting-family-planning-where-its-needed/feed/5After the Summit: Down to Earthhttp://rhrealitycheck.org/article/2012/07/25/after-summit-down-to-earth/?utm_source=rss&utm_medium=rss&utm_campaign=after-summit-down-to-earth
http://rhrealitycheck.org/article/2012/07/25/after-summit-down-to-earth/#commentsWed, 25 Jul 2012 19:11:35 +0000We need to recognise that this Family Planning Summit is just a first step, and that it is crucial that we use the energy of the summit to drive us forward. We have to maintain momentum, and we have to do that by moving fast.

On the day of the London Summit on Family Planning, I left the hall a little late. The seats were already stacked away, the stage was bare, the screens had gone, most of the delegates had departed, and the cleaners were sweeping up discarded order papers and agendas. It might have never happened.

I suppose, for some, there is now a niggling doubt that everything which the summit expressed – a movement asserting its significance with real vigour, hope, and energy – might similarly be forgotten.

I have no such qualms. I know that this event was a global energiser for hope. It was inspirational, and a landmark moment. Years of hard-fought advocacy, often against severe odds, began to coalesce. The political will to place family planning at the very heart of the development agenda has been secured. That is a critical shift.

There is a proviso (as there always is), and it’s a simple one. It is to recognise that this is just a first step, and that it is crucial that we use the energy of the summit to drive us forward. We have to maintain momentum, and we have to do that by moving fast.

The remarkable funds committed to family planning on July 11th need to be made available, rapidly. Every month we spend devising complex structures, procedures and systems to distribute money to the front line of family planning, is a month which imperils thousands of women’s lives.

We need to get the promised funding on stream, starting today. We have to begin by identifying priority programmes and priority countries. We need to identify the most effective ways to deliver, and we need to focus on those mechanisms that can readily be accelerated. We need to provide immediate funds to facilitate delivery. It is going to be a phased process: but the first phase has to start, and soon. It goes without saying that all our work needs to be undertaken within a rights-based framework, and it has to adhere to rigorous quality standards.

As we set about this task, there will be a pressing need to coordinate different donors and agencies to ensure that there is no detrimental duplication of effort, or conflict in delivery. We need to make this new money work harder for family planning, and by decreasing overheads we can maximise the sums that we devote to our mission – to reach the goal set by the Summit of meeting the needs of 380 million new and existing family planning users worldwide.

Civil society (which came together with such force via the Civil Society Declaration to the Summit, signed by 1,305 organisations worldwide) has a critical role to play, on a number of fronts. First, it needs to partner with policy-makers to ensure that policy environments are fully conducive to the rapid development and professional delivery of family planning programmes.

Secondly, in the vexed area of accountability, civil society needs to ensure that pledges made are fulfilled at country and international level. It also needs to hold itself accountable and to operate with total transparency. And finally, civil society needs to help protect rights, secure quality, and advocate for the implementation of SRHR regimes and programmes which are comprehensive, not partial.

Speaking for IPPF, the organisation takes its responsibilities in this area very seriously, and with such an extensive reach around the world, we feel we can play an important role in maintaining and enhancing civil society’s engagement with the whole process. It was at the express behest of the summit conveners that IPPF led the consultation with global civil society. Over 220 organizations participated in the development of the Civil Society Declaration to the London Summit on Family Planning signed by 1,305 groups. By mobilising civil society from 177 countries, a vast social movement has been secured. Given that 85 percent of those organisations are from the south, it brings the voice of the south to the table in force.

The London Summit on Family Planning was a celebration of decades of work, a very public statement of principles and new political will, a commitment of funds, and a call to arms. Now we must follow through. I am confident that we can, and we will, because world development and the lives of millions depend upon it.

]]>http://rhrealitycheck.org/article/2012/07/25/after-summit-down-to-earth/feed/1Family Planning and Safe, Legal Abortion Go Hand in Handhttp://rhrealitycheck.org/article/2012/07/23/family-planning-and-safe-legal-abortion-go-hand-in-hand/?utm_source=rss&utm_medium=rss&utm_campaign=family-planning-and-safe-legal-abortion-go-hand-in-hand
http://rhrealitycheck.org/article/2012/07/23/family-planning-and-safe-legal-abortion-go-hand-in-hand/#commentsMon, 23 Jul 2012 10:03:46 +0000The answer is not to promote contraception in order to reduce unsafe abortion, as the FP Summit did. The answer is to promote contraception to reduce unwanted pregnancy and provide safe abortion to every woman who finds herself with an unwanted pregnancy.

One in three women in the UK will have an abortion in her lifetime, most of whom will have been using contraception of some kind. Yet since as long ago as the late 1930s, there has been a split in the UK between those who insisted on promoting contraception on its own because they thought abortion was too controversial and would hold back acceptance of family planning, and those who insisted that the two go hand in hand. This split exists in many countries, not just the UK, and also within many organizations with a large membership in different countries, such as the International Planned Parenthood Federation (IPPF). It is reflected most recently in a comparison of the list of 600 groups and individuals who have endorsed the International Campaign for Women’s Right to Safe Abortion this year, and the 1300 that signed a letter circulated by the IPPF supporting the Family Planning Initiative – very different groups are on those lists. Yet all of them support the right to control fertility.

In 1994, the ICPD Programme of Action, a consensus document on the integration of sexual and reproductive health and rights, was only able to be passed if it included a “compromise” clause that called for abortion to be safe only if it was legal. This compromise was and remains a violation of public health principles and women’s human rights. ICPD failed to condemn the often 19th century, often colonial laws on abortion still in place in the criminal code in many countries. However, the Programme of Action did recognise that unsafe abortion was a major public health problem, one which to this day still affects some 22 million women every year, among whom 5 million end up in hospital with complications annually and tens of thousands die (WHO, Guttmacher). And young women, whom everyone wants to be seen to be supporting these days, are in fact most at risk of unsafe abortion and also have the least access to contraception (Shah & Åhman, RHM, May 2012).

The answer is not to promote contraception in order to reduce unsafe abortion, as the FP Summit did. The answer is to promote contraception to reduce unwanted pregnancy and provide safe abortion to every woman who finds herself with an unwanted pregnancy. That is the way to make unsafe abortion history. Abortion will not go away unless men and women stop having sex with each other or everyone is sterilised. So forget it!

The growing number of countries in both the north and south, east and west, where there is 60 to 80 percent contraceptive prevalence proves that. Research shows that women and men take up contraception in large numbers if they feel they have the right to control their fertility and have access to the means to do so. There is a huge need for information, because every new generation of young women and men will know nothing about contraception or abortion unless they have access to this information. But there is no need for “demand creation,” a retrograde concept which implies lack of interest. The steadily falling fertility rate globally, falling since the 1970s, proves that, and in every country, abortion is in there, safe or unsafe, reducing the number of births. Forty-four million abortions globally and hundreds of millions of people using contraception and sterilisation prove the huge demand for the means of fertility control. “Unmet need” is more than just lack of knowledge or interest on the part of the women and men who aren’t using contraception, or using it erratically or unsuccessfully.

Women seek an abortion if they have an unwanted pregnancy, legal and safe or not, because it’s too late for contraception. There is no split between contraception and abortion from women’s perspective, they are two sides of the same coin. Even so, many of the biggest supporters of “family planning” refuse to support women’s need for safe, legal abortion. Even worse, they always talk about abortion in negative terms. They mention it along with STIs, as if it were a disease, or treat it as an annoying problem that they wish would go away, and consider it inferior to use of contraception. They even claim that use of contraception will (or should) make it go away. But this is about the realities of people’s sex lives and how sex happens, not just about well-thought-out, planned-in-advance decisions about family formation. Many pregnancies are started without any forethought at all, and all too often as one of the consequences of sexual pressure and coercion.

Campaigns for women’s right to safe, legal abortion have been going on for at least 100 years. Many of us involved in these campaigns are still seen as annoying by people who are supposed to be our colleagues. We’re told it’s sensitive, controversial, difficult, it can’t be put on the agenda, including in the FP Summit. At the same time, many of us who are fighting for abortion rights stopped supporting “family planning” years ago, because of what happened in the past, when coercive programmes put many people off “family planning” and gave it a bad name. Some family planning supporters have blamed ICPD for the neglect of family planning, because it placed family planning in a wider context. But as Gita Sen said at the Summit, ICPD in fact sought to rehabilitate family planning and restore its good name, while the barriers to safe abortion were left in place.

Today’s supporters of family planning would like everyone to forget the coercive programmes of the past, which were target-based. But they may yet become target-based again because of “results-based financing.” So let’s not confuse opposition to coercive family planning policies with being anti-family planning. Yet, it is absolutely true that provision of contraception has been neglected in recent years – and yes, this neglect must stop. At the same time, neglect also characterises how women’s unmet need for safe abortion is treated. What needs to change is that both forms of unmet need should be taken into account – together – starting with donor and national government policies.

For example, although DFID’s development aid policy has long been to fund both family planning services and abortion services, in their roll-out of these policies, funding for family planning is (I am told) separated from funding for safe abortion. That is, it is managed by different people and in different programmes within DFID and in the recipient countries, and these different people may not work closely together or know what each other are doing. Yet DFID did not see a problem in agreeing to a family planning initiative in which funding for abortion is excluded. They fund abortions anyway, they say, so what’s the problem? The problem is that separating abortion from family planning at the programmatic level allows some countries to keep abortion legally restricted and not take responsibility for unsafe abortion.

Then there’s the United States, where support for family planning by USAID has been the highest in the world for many years now (but not in constant dollars), while safe abortion services are not funded by them at all. Since ICPD, however, the US has funded post-abortion care, which was invented at ICPD as a way to save women’s lives who had had an unsafe abortion. Unfortunately, the evidence that post-abortion care has in fact saved many women’s lives since ICPD is sparse and not compelling. Yes, the number of deaths from complications of unsafe abortion has fallen a lot, but this may be due to self-medication with misoprostol replacing life-threatening methods.

In fact, once ICPD was over, this so-called post-abortion care should have been rejected as unethical, because it allows harm to be done unchallenged and forces health care providers to clean up the mess without the support of the law. Under U.S. aid policy, even countries where abortion is legal who tried to use USAID funds for safe abortions as well as for contraception and sterilisation, in integrated programmes, had their “family planning” funding stopped. Research has now shown that this leads to higher rates of unwanted pregnancies and abortions in those very same countries, proving how illogical such a policy is/was. Will that evidence, published only recently, lead to a change in USAID policy? Unlikely. Too sensitive. And meanwhile, a violent and fanatical anti-abortion movement flourishes in the US, where some of the most punitive and misogynistic barriers to safe abortion are being implemented with near impunity, in one state after another.

The anti-abortion movement is also anti-family planning. For years, they were very circumspect about this as they feared, quite rightly, that it would lose them support. But the current Vatican has helped to bring anti-abortion opposition to both contraception and assisted conception out in the open again. This is evidenced in campaigns to ban emergency contraception and assert conscientious objection to providing contraceptives, e.g. by pharmacists. But still, many in the family planning movement do not support the right to safe abortion.

In light of the Family Planning Summit, it is a good time for abortion rights activists who have ignored family planning to link up with the family planning movement, and help to ensure that services have a rights-based approach. It is also a good time for all family planning colleagues to support the right to safe, legal abortion alongside the right to access contraception and sterilisation – and talk about abortion as a legitimate part of fertility control, a solution to unwanted pregnancy, a public health necessity for women, and a legitimate health care service. All of us should acknowledge the huge unmet need for safe, legal abortion services as well as for contraception and sterilisation services, and ensure that they are provided – and funded – together.

Many effective contraceptive methods, condoms, two types of emergency contraceptive pill and two very safe methods of early abortion – all on the WHO essential medicines list – can and should be provided at primary health care level. This includes medical abortion pills and manual vacuum aspiration for abortions up to 9 to 10 weeks. Some of these can even be provided during home visits by community-based health workers – the pill, condoms, injectables, emergency contraceptive pills and medical abortion pills for early abortions – as long as there are nurses, nurse-midwives or other mid-level providers who have been trained to do so. The evidence is there -– this is all safe and effective. Moreover, the legitimate sort of post-abortion care, i.e. the kind that happens after safe abortions, needs to include information about and provision of contraception, just as post-partum care ought to do. So, even programmatically and clinically, the integration of family planning and abortion makes more sense than ever.

]]>http://rhrealitycheck.org/article/2012/07/23/family-planning-and-safe-legal-abortion-go-hand-in-hand/feed/14Will the London Family Planning Initiative Measure Up?http://rhrealitycheck.org/article/2012/07/23/will-london-family-planning-initiative-measure-up/?utm_source=rss&utm_medium=rss&utm_campaign=will-london-family-planning-initiative-measure-up
http://rhrealitycheck.org/article/2012/07/23/will-london-family-planning-initiative-measure-up/#commentsMon, 23 Jul 2012 08:58:06 +0000For those of us trying to discern whether the rights of women will truly be at the center of this Family Planning Initiative, as promised by DFID and the Gates Foundation in response to our months of advocacy, there were moments of disquiet.

Given the constant ultra-conservative attacks on this most basic of rights – the right of women to control their fertility – last week’s London Family Planning Summit had in some respects a refreshing quality. Contraception was affirmed, discussed and touted, loudly and publicly. Numerous media articles published for the Summit highlighted the economic benefits of investing in contraception, and the enormous potential to save lives, both maternal and new born.

A “can-do” atmosphere prevailed. Hosts Melinda Gates and Andrew Mitchell, the UK Minister for International Development, made significant new pledges of funding for family planning in the poorest countries. For Gates, this was an additional 560 million USD over 8 years, and for the UK’s international development arm, DFID, an additional 800 million USD over the same period. Prime Minister David Cameron gave by far the most rousing speech outlining his personal commitment to women’s rights and to ensuring that the fight for women’s empowerment is at the core of the post-2015 development framework that will replace the current Millennium Development Goals. Importantly, Cameron co-chairs the UN Panel of Eminent Persons tasked with developing this new framework.

High-level government officials and heads of State, from India to Uganda, announced increased support, financial and programmatic. Some couched this support in terms of “Family Planning,” given the topic chosen by the organizers. Many, particularly from African governments, mindful of national programs and their own commitments to the now 18-year-old agreement reached at the International Conference on Population and Development, insisted on “sexual and reproductive health and reproductive rights” and a full package of services and information rather than a stand alone investment that would reinforce siloed approaches. Providing adolescent girls with information and services was highlighted as a key intervention; when 2/5 of girls in Sierra Leone have their first child between the ages of 12 and 14, that is indeed an urgent need.

All well and good — but for those of us trying to discern whether the rights of women will truly be at the center of this Family Planning Initiative, as promised by DFID and the Gates Foundation in response to our months of advocacy, there were moments of disquiet. Several speakers made it clear that their national plans involved hard targets for increasing the number of users of contraception, rather than simply making contraception available and accessible, which the ostensible goal of the Summit. For example, the representatives of Indonesia and Bangladesh spoke in terms of achieving certain ambitious contraceptive prevalence rates and total fertility rates – thus raising the very real possibility that coercion might result without safeguards. The Additional Secretary of Health of India outlined her government’s plan for post-partum IUDs for the 12 million women who deliver in institutions. These women are routinely discharged very quickly after childbirth – how much time will they have to decide whether to “accept” an IUD in these conditions?

Then, at the side session on Monitoring and Accountability in late afternoon, we heard for the first time that something about this Initiative was going to be hard to do: providing 120 million women with access to services in some of the poorest countries on earth? No. Ensuring a reliable supply of contraceptives in faraway places? No. What was going to be hard to do was “measuring human rights.” Evidently, the members of the Initiative’s Monitoring & Accountability Working Group at work need to familiarize themselves with the extensive quality of care and human rights literature on the subject, notably that produced by the Population Council and the World Health Organization. It would certainly help if representatives of women’s groups and of human rights groups were invited to join this Working Group, for a start.

The human rights of women must be measured when one is spending $4.6 billion on an initiative that is supposed to, precisely, uphold their rights. Measuring whether there is coercion in services is not hard to do. Measuring whether this is a wide range of methods available is not hard to do. Measuring whether women are satisfied with the services they receive is not hard to do. If programs do not measure these and other aspects of human rights and quality of care, however, they will send a clear message that the human rights of women are a distraction, and that something else is more important – controlling that pesky African fertility, perhaps? Let’s see whether the Initiative measures up to its claims.

]]>http://rhrealitycheck.org/article/2012/07/23/will-london-family-planning-initiative-measure-up/feed/0The Morning After: An Initial Assessment of the London Family Planning Summithttp://rhrealitycheck.org/article/2012/07/16/morning-after-beginnings-an-assessment-fp-summit/?utm_source=rss&utm_medium=rss&utm_campaign=morning-after-beginnings-an-assessment-fp-summit
http://rhrealitycheck.org/article/2012/07/16/morning-after-beginnings-an-assessment-fp-summit/#commentsMon, 16 Jul 2012 21:16:36 +0000Melinda Gates anointed herself as the new saviour of women's and children's health, and the press ate it up in both pictures and words. A truly Hollywood event, except this is not entertainment. This is women's lives.

From a communications point of view, the FP Summit was a raving success. Newspapers, TV and radio all over the world covered it. Around the globe everyone reached by the media heard how wonderful family planning is and how neglected it has been, the Lancet launched a special edition, Guttmacher and others released facts and figures showing the extent of unmet need. Across the women’s health movement the listserves, Facebook and Twitter were full of it. All in all, the day – and many of the messages to which it gave birth – had enthusiastic, even missionary, overtones.

On the absolutely fabulous side, Melinda Gates’ challenge to the Pope to acknowledge that contraception is ‘not controversial’ even among Catholic women, is likely to rock the foundations of the Vatican’s whole policy on abstinence, condoms, and contraception from the grassroots of the Catholic church up. It was God’s gift to Catholics for Choice, who will be promoting Condoms-for-Life and safer sex at the upcoming AIDS conference later this month.

Also on the plus side, there were representatives of governments and many, many others who are making progressive change happen in their countries, and who spoke out about it. These are people who can make a big difference when they get home who did support comprehensive sexual and reproductive health and rights from the podium and the floor of the meeting, and who insisted that family planning services can only be provided within the context of integrated services. There were people who needed to learn what it was all about, some of whom were too young to have lived the history, but who came with strong pro-choice views.

The media exposure of the value of family planning has a huge potential for good, because it will have reached people who didn’t know family planning existed or whether it’s good for them and safe, and others who have never had a chance to talk about these matters with others. It will also have put fertility control as a public good on the map around the world. And hopefully it will spur those with expertise in sexuality and reproduction to start talking about what they know, and what is and is not true among all the hoopla, and to assert that the power of money must not be allowed to take precedence over public health values and human rights principles, or the values of knowledge and truth.

On the oh-God-help-us-no-no-no side, though, Melinda Gates anointed herself as the new saviour of women’s and children’s health, and the press ate it up in both pictures and words. Some of the best people in the field of sexual and reproductive health ere unexpectedly uncritical singing the praises of this wonderful opportunity. Perhaps not surprising given the historical shortfall in funding for family planning.

A golden moment, the kind in which big money and a Tory government are at home, stage-managed by a slick public relations company called McKinsey (which describes themselves as “the trusted advisor and counsellor to many of the world’s most influential businesses and institutions”). With big pharma, having abandoned contraceptives for many years, talking about the opportunity (“70 percent of this market is under-served”) to make a profit from family planning needs and then give some of it back to women – as a charitable gift. Patting each other on the back for being so wonderful as to finally have recognised that women have health needs they can exploit. A truly Hollywood event, except this is not entertainment.

This is women’s lives.

This golden moment, which had to happen mainly because so many governments have failed to take responsibility for the public health needs of their citizens, for maternal health, family planning, abortion, sexual health, in the only equitable manner that works – by providing publicly funded, well-resourced services.

It was a day that showed the world it was possible for one very well-meaning woman, backed by the power and money of her husband, to direct global policy and claim ownership of the provision of family planning to 120 million women and at the same time, to disparage and stigmatise women’s need for abortion to the entire world – and get away with it without being challenged. She had the courage to challenge the Pope. It is a shame that a summit attended by many of the world’s experts on these subjects could not emulate her bravery and challenge her in return.

She was not the only one who got away with it. The Summit also gave the podium to and applauded politicians from countries where millions of women have the very unmet need for contraception in whose name this Summit was called: women who are still dying from unsafe abortions because their governments are too cowardly to make abortion legal and safe; and women who are dying from complications of pregnancies because they have no access to life-saving maternity care. Countries that since the sixties have received hundreds of millions if not billions of U.S. dollars for family planning, which have as good as disappeared, or been squandered and misspent.

It included representatives of the very same private sectors whose services and prices for contraceptive methods and safe abortions remain inaccessible to and unaffordable for many in the world’s population who need them, especially young women and men. And not only in low- and middle-income countries, but also in the United States, a country whose health industry has made life hell for Barack Obama for trying to make health care even a little bit more affordable, excluding abortion of course, for millions of disenfranchised people. The United States – a country that has the biggest and most violent and aggressive anti-choice movement on earth, second only to the Vatican, and some of the highest unintended pregnancy rates in the developed world, especially among poor women.

The Prime Minister of the United Kingdom, the Right Honourable David Cameron, addressed the meeting and got a standing ovation for a speech about the importance of empowering women, a speech that stank of hypocrisy. A Prime Minister who is responsible for indefensible spending cuts that are adversely affecting women, young people, and children above all, including cuts in family planning, sexual health services, and welfare, at a time when it has never before cost so much to raise a family. Whose Secretary of State for Health is selling off our National Health Service piece by piece, who has wasted public time and at least £1 million in public money harassing some of the real heroes of women’s rights, that is, abortion service providers, for no credible reason. Whose Minister for Public Health put an anti-choice group on the government’s sexual health advisory group “for the sake of balance” and to propitiate anti-abortion fanatics in Parliament – a Minister who described abortion as a “sensitive” issue, after 45 years of safe, legal abortions (except for women in Northern Ireland, of course).

And now it’s the morning after. How to go on from here and engage in what will happen? It’s a pity about Melinda Gates’ prejudices against abortion. I hope she will reconsider them because it would make her a far more credible ambassador for this cause, which after all does not belong to her.

]]>http://rhrealitycheck.org/article/2012/07/16/morning-after-beginnings-an-assessment-fp-summit/feed/1Looking for Human Rights at the Family Planning Summithttp://rhrealitycheck.org/article/2012/07/11/looking-human-rights-at-family-planning-summit/?utm_source=rss&utm_medium=rss&utm_campaign=looking-human-rights-at-family-planning-summit
http://rhrealitycheck.org/article/2012/07/11/looking-human-rights-at-family-planning-summit/#commentsWed, 11 Jul 2012 19:00:35 +0000At the family planning summit in London, I waited to hear leaders of different countries recognise the centrality of women’s human rights, their sexual and reproductive rights. But disappointingly, although a few notable references were made to these issues by some leaders, women’s human rights were not appropriately addressed.

Arriving at the summit (organised by the UK Department for International Development and Bill and Melinda Gates Foundation) this morning I was reminded of the testimony of a woman living in Ouagadougou, interviewed by Amnesty International a few years ago:

“After seven pregnancies and five live children, I told my husband that I wanted to use contraceptive methods but my husband refused and told me that if I did this, I should return to my mother’s home. I therefore had to obey him.”

In Burkina Faso, Amnesty International collected numerous testimonies of women who were denied the right to decide on contraceptive use. In many cases husbands and male relatives opposed the use of contraceptives and criticized medical professionals for providing contraceptive products and advice to their wives or other female members of their families.

Amnesty International has documented similar experiences in other countries as well. In Indonesia, for instance a human rights activist told Amnesty International, “[It] is very taboo for an unmarried person to look for contraceptives… S/he will be seen as looking for free sex.”

Laws in Indonesia provide that access to sexual and reproductive health services may only be given to legally married couples. Unmarried individuals are simply denied access to these services.

Nearly 20 years ago, governments at the International Conference on Population and Development agreed by consensus that respect for women’s reproductive autonomy is the cornerstone of population policy. This was a vital step as this moved the debate away from a narrow focus on demographic targets and family planning methods towards a more comprehensive approach to sexual and reproductive health.

However, women and girls around the world are systematically denied the right to make decisions about their sexual and reproductive lives free of discrimination, coercion, and violence. As I listened to leaders from different countries express their commitments towards family planning and meeting the unmet need of millions of women for contraception, I was desperate to hear them reaffirm the commitment they made 20 years ago. I waited to hear them recognise the centrality of women’s human rights, their sexual and reproductive rights to this initiative. But disappointingly, although a few notable references were made to these issues by some leaders, women’s human rights were not appropriately addressed.

I spoke to Prof Gita Sen (of the Southern feminist network, DAWN, and the Indian Institute of Management Bangalore) about her thoughts on the Summit and she said “The reason we all got together in Cairo 20 years ago was a collective recognition in the women’s human rights community and among family planning policy people in governments/agencies that top-down family planning approaches, as in India during the political Emergency of the mid-1970s and after, have serious potential for coercion.”

“Such approaches have done incalculable harm to the legitimacy of family planning and therefore to the rights and access of millions of women and men, young and old, married and unmarried, to safe and effective contraception. If money and attention are coming back to this field, it would be prudent if not wise for funders, agencies and governments and I may add, the large community of international and national NGOs to refocus on those lessons, and to bring human rights into the centre of this renewed agenda. Not just in the form of principles but of practical methodologies for how policies and programmes are implemented and monitored, how health workers are motivated, rewarded or punished, and how accountability for non-coercion, equity and access are built in.”

There is overwhelming evidence that a silo-ed approach to family planning just does not work. What is needed is an integrated approach within the framework of comprehensive sexual and reproductive health and rights. To meet the unmet sexual and reproductive health needs of millions of women and girls around the world sexual and reproductive health services must be provided with attention to quality of care and with full recognition of human rights.

The ICPD Programme of Action unequivocally recognizes that population targets and quotas should not condition whether and how services are delivered and that no one should be coerced in any way regarding their sexuality and reproductive lives. A target driven approach -– such as one which focuses exclusively on meeting family planning targets and fails to include protection for women’s human rights is likely to result in more harm than good.

I spoke to Francoise Girard, President of the International Women’s Health Coalition, about her thoughts on the focus on targets and incentives as key drivers for the Summit.

She said:

“Renewed attention to contraception is a good development, but the commitments made this morning by governments run the gamut from providing increased access – which is good – to meeting specific targets for contraceptive use. These are very different ways of approaching program design and implementation. If the end result is to be 80 percent contraceptive prevalence rate, as was mentioned by Bangladesh this morning, how will this be done in practice? By setting targets for providers and health institutions to “put women on contraceptives.””

“We also heard quite a few Ministers discuss post-partum contraception,” Girard continued. “The power dynamic after childbirth can and does lead to women being sterilized or fitted with an IUD without choice or information -– witness recent scandals in India, Namibia, Kenya. That worries us greatly.”

As I listened to discussions through the day I kept on thinking “What about accountability?” The issue was the focus of discussion in a parallel session in the afternoon. While the panelists spoke about indicators, data and drivers for progress, accountability for human rights was mentioned as an “optional feature.”

While quantitative evaluations and hard data are necessary to measure progress, they fail to address the barriers and challenges faced by women and girls in their attempts to realise their sexual and reproductive rights. The discussions today did not go a long way in addressing the need to develop an accountability framework that is responsive to the root causes of high unmet need for sexual and reproductive health. A framework that tracks governments’ human rights obligations and not just resources and results. Much more needs to be done to ensure that these issues are not sidelined.

The writing on the wall is clear: women’s human rights and quality of care must be at the core of any such initiative. Any failure to do that will result in more harm than good being done and will undermine the sustainability of this initiative.

]]>http://rhrealitycheck.org/article/2012/07/11/looking-human-rights-at-family-planning-summit/feed/0Take a Pill Every Day, I Was Told, and Presto, I Didn’t Have to Worry About Getting Pregnant!http://rhrealitycheck.org/article/2012/07/11/take-pill-every-day-i-was-told-and-presto-i-didnt-have-to-worry-about-getting-pre/?utm_source=rss&utm_medium=rss&utm_campaign=take-pill-every-day-i-was-told-and-presto-i-didnt-have-to-worry-about-getting-pre
http://rhrealitycheck.org/article/2012/07/11/take-pill-every-day-i-was-told-and-presto-i-didnt-have-to-worry-about-getting-pre/#commentsWed, 11 Jul 2012 07:40:41 +0000All I had to do was take a pill every day, I was told, and hey presto, I didn't have to worry about getting pregnant if I didn't want to, and it worked! But oh, if only it had all turned out to be that easy.

]]>I was among the first generation of women in the 1960s to experience the miracle of the pill just at the age when I was wanting to start having sex. All I had to do was take a pill every day, I was told, and hey presto, I didn’t have to worry about getting pregnant if I didn’t want to, and it worked! But oh, if only it had all turned out to be that easy! Like one in three women in the UK today, a country where contraceptive prevalence is almost as high as it can get, I needed an abortion several years later. Again, I was lucky, the 1967 Abortion Act meant I was able to get a legal abortion. The lesson is simple—while contraception continues to be a miracle, because it helps people not to have children if and when they don’t want to, it is not enough on its own and it never has been.

Family planning has been out of the news for a long time, and suddenly it’s back. Welcome! Bring out the red carpet! Women and men need contraception now as much as they ever have, and young women and men who are beginning to explore their sexuality together need contraception and condoms more than anyone. But there has been a lot of water under the bridge since family planning was promoted as the cure-all for the world’s ills in the 1960s when the pill came out, and everyone needs to study that history anew so that the same mistakes, of which there have been many, and the same narrow vision, are not repeated.

My generation of women’s health activists, along with an entire generation of researchers, service providers and policymakers who brought their knowledge together at the International Conference on Population and Development in 1994, got the world to recognise that the need for the means to control fertility, which is as old as history itself, was part of a much broader set of needs related to reproduction and sexuality, and that these were inextricably connected. These include: being able to have sex without fear of negative outcomes, being able to have sex if and only if we want to and only with whom we want to, being able to have the children we want, being able to get pregnant at all, being able not only to survive pregnancy but also still be in good health, being able to have a safe abortion without fear of death or condemnation when an unwanted pregnancy occurs, being able to protect ourselves from sexually transmitted diseases, and being able to get treatment for all the many causes of reproductive and sexual ill-health, which start with menstruation and menstrual problems, and continue into old age with things like breast and prostate cancer, and uterine prolapse.

There is indeed a huge unmet need in today’s world, but the unmet need for contraception is only a fraction of the unmet need for sexual and reproductive health, and for sexual and reproductive rights. The results we should be working for encompass every aspect of the issues I have just named, and those in turn must be seen in the even wider context of the right to health, social justice and an end to poverty and violence—which were the real point of the Millennium Development Goals—not the measurable targets.

]]>http://rhrealitycheck.org/article/2012/07/11/take-pill-every-day-i-was-told-and-presto-i-didnt-have-to-worry-about-getting-pre/feed/2The “Rights” Kind of Progress for Womenhttp://rhrealitycheck.org/article/2012/07/10/rights-kind-progress-women/?utm_source=rss&utm_medium=rss&utm_campaign=rights-kind-progress-women
http://rhrealitycheck.org/article/2012/07/10/rights-kind-progress-women/#commentsTue, 10 Jul 2012 17:41:03 +0000I recently had the privilege of talking with women across Guinea and the messages I heard over and over again were these: I want to live a healthy life... to earn a living... to educate my children.

During my trip to Guinea a couple of weeks ago, I had the privilege of talking with women across the country about their lives and what they most want for themselves. The messages I heard over and over again—not just in Guinea but in places as diverse as India, Tanzania, Ethiopia—were these: I want to live a healthy life… to earn a living… to educate my children.

What can make these things possible?

An important part of the answer is family planning—an extraordinarily simple, but prized, tool that allows women to keep themselves healthy and care for their children. A woman’s ability to decide the number, spacing, and timing of children can determine the course of her future and that of her family.

As I write, a momentous opportunity is just around the corner. On July 11, I will attend a landmark Family Planning Summit in London, where global leaders will convene to garner the resources and political commitments needed to reach an additional 120 million women around the world with family planning by 2020.

It’s about rights. Indeed, reaching 120 million women is an ambitious and laudable goal. But as we seek to reverse decades of family planning neglect, we can’t lose sight of the single most important factor for success: upholding women’s sexual and reproductive rights. The progress we proclaim eight years from now hinges not on whether we’ve merely reached 120 million women and girls with family planning services—but whether they were able to make informed decisions about their health and that they made those decisions completely free from coercion and without barriers such as limited family planning options.

For women in developed countries, this is usually simple enough—when we visit our doctor, we can reasonably expect to get the information we need to make an informed choice that suits our lifestyle and long-term plans, whether it’s condoms, pills, hormonal implants, or permanent methods. With relative ease, we can schedule a procedure or pick up our method of choice at a local pharmacy.

But for women and girls in Ghana, Niger, and many other developing countries, the reality is very different. Many will walk long miles with their children to reach a health center, only to learn that their method of choice is out of stock, forcing them to make the journey again or worse, to forgo contraception altogether.

Contraceptives can only go so far. Keeping clinics fully stocked is merely a fraction of the equation. Women also need accurate information to understand how family planning can affect their health so they can make informed choices that best support their individual needs. This is only possible when local health providers are properly trained to offer high-quality counseling and have the vital skills needed to uphold women’s sexual and reproductive rights. Over 70 years, EngenderHealth has worked in more than 100 countries around the world to imbue generations of health providers with these very qualifications and give them the means to empower their clients to exercise their rights.

Men have an important role to play. Finally, true progress will be no more than a distant dream if we don’t recognize men’s role in supporting their partners’ health. Too often, men wield decision-making power when it comes to sexual relations or reproductive health. But through our pioneering work to engage men in Tanzania and 25 other countries, we have seen how men can be the most powerful champions for their partners’ health, whether by accompanying their pregnant wives to health centers or becoming outspoken advocates within their communities and promoting family planning as key to improving health and greater prosperity.

We know what the factors are for success. Let us build on our years of rich experience and harness this momentous opportunity before us to achieve the right kind of progress for women. Learn more about family planning at our special summit webpage, including what you can do to lend your voice to this cause and help women around the world build the best possible future for themselves and their families.

]]>http://rhrealitycheck.org/article/2012/07/10/rights-kind-progress-women/feed/1Perspectives on the London Family Planning Summit 2012: Women’s Human Rights Must Be at the Center of Family Planninghttp://rhrealitycheck.org/article/2012/07/10/womens-human-rights-must-be-at-center-family-planning/?utm_source=rss&utm_medium=rss&utm_campaign=womens-human-rights-must-be-at-center-family-planning
http://rhrealitycheck.org/article/2012/07/10/womens-human-rights-must-be-at-center-family-planning/#commentsTue, 10 Jul 2012 09:38:48 +0000This week’s summit is a crucial opportunity to re-invigorate international efforts to provide millions of women with access to the contraception they so desperately need. Yet increasing the availability of contraception is just one aspect of ensuring reproductive health, and cannot be seen in isolation.

In 1996, a Peruvian woman named María Mamérita Mestanza Chávez died from complications of a forced sterilization in Peru. She was a low-income, indigenous Peruvian woman, who was coerced into agreeing to sterilization by government officials and was repeatedly denied follow-up medical care when complications ensued. María died from post-surgical medical complications seven days after her surgery.

María’s story was only one of many cases of coercive sterilizations in Peru — the tragic and cruel consequences of family planning practices that leave women’s human rights out of the equation. Her story reminds us how important it is that the government officials, global advocates and donors participating in this week’s Family Planning Summit in London keep stories like María’s in mind.

This week’s summit is a crucial opportunity to re-invigorate international efforts to provide millions of women with access to the contraception they so desperately need. Yet increasing the availability of contraception is just one aspect of ensuring reproductive health, and cannot be seen in isolation. The summit must recognize women’s right to a full range of comprehensive sexual and reproductive health services. Without access to sexuality education, safe and legal abortion, and a range of other essential services, women’s reproductive rights will still be far from being achieved.

Last month, the Center for Reproductive Rights joined 326 other organizations and individuals from around the world to issue a joint statement highlighting the urgent need for family planning policies to recognize and protect women’s autonomy and human rights. For 20 years, the Center has documented the devastating consequences — both intended and unintended — of reproductive health policies that fail to do so. And we have fought legal battles in courts and the UN on behalf of the women who have suffered egregious human rights abuses and violations of their basic reproductive rights, including discrimination against marginalized women seeking access to care, mistreatment by health workers, not being provided information on family planning and involuntary sterilization of women.

While contraceptive information and services are an essential part of the health services that women need throughout their lives, efforts to simply increase the use of contraceptives can have negative consequences if women are not empowered to decide for themselves when and how to use them. If the initiative put forth in London this week fails to tackle the myriad obstacles women face in accessing sexual and reproductive health services – lack of information, requirements that their spouses or parents give their consent, bans on certain methods, discrimination, unavailability of services in certain areas, inadequate systems to deliver services – it will stop far short of addressing the real barriers to women’s reproductive rights.

And international human rights bodies agree.

In María’s case, the Center for Reproductive Rights filed a case with local and regional partners on behalf of her family at the Inter-American Commission on Human Rights (IACHR). As a result, the Peruvian government agreed to pay moral damages to María’s husband and seven children, as well as significant compensation for their health care, education and housing. The government also agreed to conduct an in-depth investigation and to punish those responsible for the violations of Peruvian and international legal standards.

But Peru isn’t the only place these violations have occurred. In 2009, the Center filed a complaint against Chile before the IACHR on behalf of F.S., a young woman living with HIV who was sterilized without her knowledge or consent. F.S. was diagnosed with HIV in 2002 soon after learning she was pregnant. She was referred to a state hospital for HIV treatment during pregnancy. She and her husband had plans to have more children and F.S. never requested sterilization. She was forcibly sterilized at the hospital immediately after giving birth. This is another example of a government failing to protect a woman’s reproductive rights, her human rights.

States must ensure that women can exercise their reproductive rights. The decision to use contraceptive methods is voluntary and should never be forced on any woman, no matter her ethnicity or socioeconomic background.

But local activists, global advocates and civil society organizations cannot act alone as a watchdog for reproductive rights. States – as donors and implementers of family planning policies – and international donors must ensure that there are monitoring and accountability systems in place to ensure the kinds of violations María suffered are not repeated. I’ll be in attendance at this week’s Family Planning Summit and will be calling for human rights to be front and center of the discussions, moving the conversation from contraceptives alone to reproductive rights as human rights.